Friday, 11 July 2014

Politics: Are patient-assistance programs bribery?

Have you been bribed? Patient-assistance prgroammes. #MSBlog #MSResearch

"We have posted several times in the past about the cost of DMTs in the US and whether or not the current situation is sustainable. The following article in this week's NEJM gets to the heart of the issue and uses MS as an example. The article implies that the co-payments needed to cover the costs of the drug that being paid by Pharma companies is resulting in high prices and may be unethical. The author hints these may in fact be classed as bribery. Interesting? It is clear that the incentive to keep prices low in the US does not apply. Politicians are beginning to take note and it is only a matter of time before they do something about it. When you take a macro-economic look at what is happening it is not good for the world. Why should US tax payer be subsidizing drug development costs for the world? Why do big Pharma have to rely on the US market to make most of their profits? The article below just scratches the surface of these issues."

"Despite  the issues raised in this article we must not forget the many MSers who would not be on DMTs if it was not for patient assistance programmes. As a neurologist who looks after MSers the advantages of these programmes for individuals seem obvious; this is another conflict between individuals and the larger society."

David Howard. Drug Companies' Patient-Assistance Programs — Helping Patients or Profits? N Engl J Med 2014; 371:97-99.


..... Implementing patient cost sharing in the form of copayments, coinsurance, and deductibles is one of the more reliable methods for reducing health care costs. But imposing cost sharing reduces patients' demand for medical care, which sets the interests of insurers at odds with the interests of health care providers and drug and device manufacturers, who generally benefit when patients use more services......

..... Pharmaceutical manufacturers have attempted to blunt the impact of drug copayments and coinsurance on patients by funding patient-assistance programs. These programs offset patients' out-of-pocket drug costs, typically on generous terms. Biogen's program for its multiple sclerosis drug dimethyl fumarate, for example, caps patients' copayments at $10 per month, less than 1% of the total cost of the drug.....  

...... Assistance programs are a triple boon for manufacturers. They increase demand, allow companies to charge higher prices, and provide public-relations benefits. Assistance programs are an especially attractive proposition for firms that sell particularly costly drugs.....

...... Faced with high out-of-pocket costs, some patients may decide against taking an expensive medication. Patient-assistance programs can convert such patients from nonusers to users. Programs must incur costs for patients who would have used the drug even in the absence of a program, but manufacturers can afford to pay a lot of $25 or $50 copayments in return for even a small increase in the sales of a $50,000 drug.....

..... Patient-assistance programs may lead to higher drug prices as a result of the interplay between patient demand and prices. Economic theory predicts that if patient demand becomes less sensitive to prices, manufacturers of on-patent drugs will respond by setting higher prices. There is evidence to support this theory. In 1989, Germany began requiring patients to pay higher out-of-pocket costs for drugs with prices that exceed those of similar drugs. After this policy was implemented, drug prices dropped by 10 to 26%....

..... The Office of Inspector General of the Department of Health and Human Services (DHHS) has warned that patient-assistance programs may violate the federal anti-kickback statute by providing a “remuneration” that illegally induces consumption of services.....


  1. This issue highlights the difference between capitalist and socialist healthcare systems. Both are broken and need fixing. May be the solution is a hybrid system.

  2. Americans are being fleeced to support the medical needs of the rest of the world. Patient assistance programs are what allows the majority of US patients to afford medications. Many patients use whatever medication is available that provides the most financial support. I know I cannot afford $5000USD/$3000GBP per month. "The Office of Inspector General of the Department of Health and Human Services (DHHS) has warned that patient-assistance programs may violate the federal anti-kickback statute by providing a “remuneration” that illegally induces consumption of services." That sounds like Obamacare that forces us to become consumers in the marketplace. Please just ignore America for a few years --- we have some internal problems we need to deal with. Cheers!

  3. I tell myself that drug prices are between the drug companies and the insurance companies. Otherwise I'd feel overwhelmed with guilt, taking a med that is artificially above my annual income for most years. I take more from the system than I give ... and I'm perfectly functional and productive.


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